A 67-Year-Old Woman with Moderate Chronic Obstructive Pulmonary Disease Comes

A 67-year-old woman with moderate chronic obstructive pulmonary disease comes to the physician to discuss plans for upcoming air travel from Boston to California.  She leads a sedentary lifestyle and has mild occasional cough but no significant dyspnea with household activities.  One year ago, she was hospitalized with exacerbation of chronic obstructive pulmonary disease and was treated with noninvasive ventilation, corticosteroids, and antibiotics.  The patient's other medical problems include coronary artery disease with stent placement 2 years ago.  Her left ventricular ejection fraction is normal.  Current medications include tiotropium, salmeterol, albuterol as needed, aspirin, clopidogrel, atorvastatin, metoprolol, and losartan.
Her blood pressure is 122/70 mm Hg, pulse is 75/min, and respirations are 16/min.  Pulse oximetry is 96% on room air at rest.  Pulmonary examination shows minimal bilateral end-expiratory wheezes.  Cardiac examination is within normal limits.  There is no peripheral edema.  Forced expiratory volume in 1 second on spirometry 6 months ago was 55% of predicted.
Which of the following is the best next step in management of this patient?

A) Cardiopulmonary exercise testing
B) Hypoxia altitude simulation test
C) No further evaluation is needed
D) Six-minute walk test
E) Supplemental oxygen at 2 L/min for the flight

Correct Answer:

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